Insuffisance cardiaque aiguë à fraction d’éjection altérée : signes électrocardiographiques associés à la mortalité à l'institut de cardiologie d'Abidjan

IF 0.3 Q4 Medicine
I Coulibaly , JJ N'Djessan , A Adoubi , H Yao , S Gbetchedji , E Soya , MP Ncho-Mottoh , I Angoran , S Kouamé , G Tro , C Touré , JB Anzouan-Kacou
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引用次数: 0

Abstract

Introduction

Heart failure with impaired ejection fraction (HFIEF) represents the end-stage of most cardiac diseases, and is responsible for a high mortality rate. In order to identify patients at risk, numerous clinical and paraclinical prognostic factors have been proposed. The electrocardiogram (ECG), easy to perform and inexpensive, retains a powerful role in the prognostic evaluation of heart failure patients. The aim was to evaluate ECG signs associated with mortality in a retrospective cohort of patients with ICFEA.

Methodology

The study was observational and analytical based on retrospective data collected from patients benefiting from a primary hospitalization for ICFEA at the Abidjan Heart Institute from January 2018 to July 2020.

Results

Of the 370 patients included, 197 had died by August 1, 2020, representing an overall mortality of 53%. Mortality progressed gradually up to one year, then remained unchanged up to 30 months.

In multivariate Cox regression including ECG variables only, the presence of intra-ventricular conduction disorders (OR: 1.80; 95% CI [1.01–3.25]), microvoltage (OR: 1.82; 95% CI [1.05–16]), and pathological Q waves (OR: 1.70; 95% CI [1.02–2.83]), were significantly associated with overall mortality. When ECG variables and clinical, paraclinical and therapeutic demographic variables were included, only the presence of pathological Q waves (OR:1.74; 95% CI [1.01–3.01]) persisted as a risk factor for mortality. Hypertension and treatment of heart failure, in particular ACEI/ARII, beta-blockers and ARM, were protective factors. The presence of Q waves was associated with a significant reduction in survival, based on curves obtained using the Kaplan-Meier model.

Conclusion

ICFEA is responsible for high mortality, mainly in the year following the 1st hospitalization for cardiac decompensation. The presence of pathological Q waves is the only electrocardiographic sign that remains statistically associated with a poor prognosis, after adjustment.

[急性心力衰竭伴射血分数改变:阿比让心脏病研究所的心电图体征与死亡率]。
导论:心力衰竭伴射血分数受损(HFIEF)是大多数心脏疾病的终末期,是造成高死亡率的原因。为了确定有风险的患者,许多临床和临床外的预后因素被提出。心电图(ECG)易于操作且价格低廉,在心力衰竭患者的预后评估中仍发挥着重要作用。目的是在ICFEA患者的回顾性队列中评估与死亡率相关的ECG体征。方法:该研究是观察性和分析性的,基于从2018年1月至2020年7月在阿比让心脏研究所接受ICFEA初级住院治疗的患者收集的回顾性数据。结果:纳入的370例患者中,截至2020年8月1日已有197例死亡,总死亡率为53%。死亡率逐渐上升至1年,然后保持不变至30个月。在仅包括ECG变量的多变量Cox回归中,存在室内传导障碍(OR: 1.80;95% CI[1.01-3.25])、微电压(OR: 1.82;95% CI[1.05-16])和病理Q波(OR: 1.70;95% CI[1.02-2.83]),与总死亡率显著相关。当包括心电图变量和临床、临床旁和治疗人口统计学变量时,只有病理性Q波的存在(OR:1.74;95% CI[1.01-3.01])仍然是死亡率的危险因素。高血压和心力衰竭的治疗,特别是ACEI/ARII, β受体阻滞剂和ARM,是保护因素。根据Kaplan-Meier模型得出的曲线,Q波的存在与生存率的显著降低有关。结论:ICFEA死亡率高,主要发生在因心脏失代偿首次住院后一年。病理性Q波的存在是唯一在统计学上与不良预后相关的心电图征象。
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来源期刊
CiteScore
0.60
自引率
0.00%
发文量
68
审稿时长
6-12 weeks
期刊介绍: Organe scientifique de référence fondé en 1951, les Annales de cardiologie et d''angéiologie abordent tous les domaines qui intéressent quotidiennement les cardiologues et les angéiologues praticiens : neurologie et radiologie vasculaires, hémostase, diabétologie, médecine interne, épidémiologie et prévention. Les Annales de cardiologie et d''angéiologie sont indexées aux grandes bases de données et publient rapidement, et en conformité avec les normes internationales de publication scientifique, des articles en français sur la pathologie cardiaque.
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